J Neurocrit Care.  2020 Jun;13(1):49-56. 10.18700/jnc.190104.

Predicting parenchymal hematoma associated with endovascular thrombectomy for acute occlusion of anterior circulation large vessel: the GuEss-MALiGn scale

• Kim J
• Kim CH
• Kang J
• Kwon OY

• KMID: 2503385
• DOI: http://doi.org/10.18700/jnc.190104

Abstract

Background
Endovascular thrombectomy (EVT) is an emergency treatment for stroke caused by anterior circulation large vessel occlusion (ACLVO). This study aimed to identify the predictors for post-EVT parenchymal hematoma (PH) and to develop a predictive tool using the identified factors.
Methods
Using the clinical and imaging data of consecutive patients with acute ACLVO who underwent EVT, we performed a multivariate binary logistic regression analysis to identify predictors for PH. With the predictors proved by the regression, we developed a scale for predicting PH using receiver operating characteristic (ROC) curve analyses.
Results
In 233 enrolled patients, the mean age was 72.3 years old, and the male proportion was 46.4%. The rate of PH after EVT was 18.0%: the rate of type 1 PH was 12.9%, and the rate of type 2 PH was 5.2%. The significant predictors for PH were basal ganglia involvement, embolism, male sex, antihyperlipidemic use, lobar infarction, and serum glucose level. We developed the GuEss-MALiGn scale with the six significant predictors. Each of these six items was placed on a Likert scale and scored as a 0 or 1. The ROC curve analysis revealed that the area under the curve was 0.771. The cutoff score for the risk of PH was >3. The sensitivity was 59.5%, and the specificity was 78.0%.
Conclusion
We propose the GuEss-MALiGn scale as a tool for predicting PH associated with EVT. Future external validation is needed to determine the reliability of this scale.

Keyword

Cerebral infarction; Middle cerebral artery; Thrombectomy; Endovascular procedures; Postoperative complications; Cerebral hemorrhage

Figure

• 

  Fig. 1. The occurrence rate of parenchymal hematoma (PH) associated with endovascular therapy (EVT) according to each item of the GuEss-MALiGn scale: comparisons between the non-PH group and the PH group. In patients with acute stroke by the occlusion at the internal carotid artery or the M1 segment of the middle cerebral artery, the six factors were associated with the occurrence of PH associated with EVT. Those factors were: the initial serum glucose (ISG) level, embolism, male sex, antihyperlipidemic (AHL) use, lobar infarction (Lobar), and basal ganglia involvement (BGI).

• 

  Fig. 2. The receiver operating characteristic (ROC) curves of the score of the GuEss-MALiGn scale for detecting the risk of parenchymal hematoma after EVT of the acute occlusion of anterior circulation large vessel. (A) For detecting the risk, ROC analysis of the score of the GuEss-MALiGn scale determined an area under the curve (AUC) of 0.771. At a cutoff score of >3, the sensitivity and specificity for detecting the risk were 59.5% and 78.0%, respectively. (B) When comparing the AUC values between the different scores in the cases that they were hypothetically the GuEss-MALiGn cutoff points, the AUC value was also the highest at 0.688 when the cutoff point was >3.

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